Anthem BCBS has entered into “bundled payment” arrangements for select surgical procedures at the Orthopedic & Sports Institute of the Fox Valley in Appleton, Wis. and at Manitowoc Surgery Center in Manitowoc, Wis.
A “bundled payment” groups and coordinates all of the charges associated with a surgery and recovery together for one pre-negotiated price. This means an individual can quickly and easily understand their potential out-of-pocket costs before surgery and results in greatly reduced paperwork for all involved.
“Think of a bundled payment like a restaurant offering a complete meal for $20 deal,” said John Foley, regional vice president of Provider Engagement and Contracting for Anthem Blue Cross and Blue Shield in Wisconsin. “You know if you choose that option that you will get a great experience that you will get a great experience that includes an appetizer, entree and dessert, and you know what it’s going to cost before the bill hits your table. That’s a bundled payment.”
“The alternative is an a la carte meal, where each item you order goes on your bill separately. This can result in some surprises by the end of the meal — especially if the prices aren’t printed on the menu.”
Anthem Blue Cross and Blue Shield’s bundled payment agreements extend beyond the costs associated with the actual surgical procedure to also include recovery and rehabilitation services, such as physical therapy. Additional peace of mind and cost certainty is provided through a performance guarantee similar to a warranty.
“The purpose of these bundled payments is to deliver high quality care and a high quality experience to Anthem Blue Cross and Blue Shield members,” said Foley. “If any additional medical services are needed within 90 days of the surgery to make the procedure a complete success there is no additional cost to the patient, so long as they return to the doctor who performed the bundled procedure.
“This cost protection is completely unique to these bundled payments. In almost any other case, patients who undergo additional procedures would be subject to additional costs in the form of deductibles, coinsurance and copays, depending on their insurance policy.”
Bundled payments are reflective of a larger trend within health care that is working to align payments with the value of the care, rather than the volume of health care services delivered.